Provider Demographics
NPI:1265641955
Name:BOSACK, LINDA BRIGIT (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BRIGIT
Last Name:BOSACK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 S 108TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-460-5500
Mailing Address - Fax:708-460-0005
Practice Address - Street 1:16001 S 108TH AVENUE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-460-5500
Practice Address - Fax:708-460-0005
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1686005OtherBCBS
IL972660Medicare ID - Type Unspecified